[Dermo-hypodermitis caused by group B Streptococcus in infants under 3 months of age: A retrospective study in two hospitals]. / Dermo-hypodermites à streptocoque du groupe B chez les nourrissons de moins de 3 mois : étude rétrospective dans deux centres hospitaliers.

BACKGROUND: Very few studies describe group B streptococcal dermo-hypodermitis in newborns. OBJECTIVES: To describe the incidence, clinical characteristics, and course of group B streptococcal dermo-hypodermitis in infants less than 3 months old. PATIENTS AND METHODS: Infants under 3 months of age, hospitalized for group B streptococcal dermo-hypodermitis at Robert Debré University Hospital, Paris, France, and at Orsay Hospital, Orsay, France, between January 2002 and August 2013, were included in a retrospective study. RESULTS: Five infants were included in this study. All the infections occurred late. Dermo-hypodermitis accounted for 7% of the overall late-onset group B streptococcal infections during the same period. Four patients were male and had a risk factor of maternal-fetal infection (prematurity/hypotrophy). Four patients had specific clinical signs of dermo-hypodermitis with septic shock features on admission. One patient had meningitis and associated parotitis. Group B Streptococcus was isolated from blood culture of all patients. Serotype III Streptococcus was identified in four cases. The duration of intravenous antibiotic therapy varied from 7 to 23 days and the total duration of antibiotic therapy was between 14 and 44 days. The progression was favorable for all the infants, with no recurrence. CONCLUSION: Dermo-hypodermitis in infants under 3 months of age is rare but could be an early indicator of group B streptococcal bacteremia and/or sepsis. Early diagnosis of this severe complication and appropriate antibiotic therapy are critical.

[Is the new vaccination schedule recommended in France adapted to premature babies?]. / Le nouveau calendrier vaccinal est-il adapté à l'ancien prématuré ?

The French 2013 immunization schedule having a goal of simplification with comparable efficacy, has decreased the number of injections and removed the injection performed at three months of age in the general population. Apart from the prevention of invasive pneumococcal infections for which it is recommended to maintain three dose primary immunization, vaccination of premature is not addressed in this new calendar. Can the extremely preterm infants (<33 weeks of gestational age) benefit from this new schedule or should we keep them in three injections schedule? The objective of this paper is to clarify this point through the data available in the literature. Children born prematurely and especially the "extremely premature" born before 33 weeks are at high risk of infections, some of them are preventable by immunization. Although there is no clinical evidence, for pertussis, pneumococcus, Haemophilus influenzae b, hepatitis B, whatever the immunogenicity criteria, immunogenicity is significantly lower in preterm than in term newborn after 3 doses primary schedule. This lower immunogenicity raises concerns about the transition to two doses, about the ability to give short term protection and booster responses. Given these data, GPIP takes the position for maintaining a primary 3-dose vaccination at 2.3 and 4 months for premature infants less than 33 weeks.

[Efficacy and safety of intravenous immunoglobulins in the management of neonatal hyperbilirubinemia due to ABO incompatibility: a meta-analysis]. / Efficacité et tolérance des immunoglobulines polyvalentes dans l'hyperbilirubinémie néonatale par incompatibilité ABO. Méta-analyse.

OBJECTIVES: ABO fetomaternal red blood cell incompatibility (ABO FMI) induces an immune hemolysis after fetal transfer of hemolyzing maternal anti-A or anti-B. ABO hemolytic disease (ABO HD) remains the most frequent cause of severe and early jaundice in newborns. High levels of unconjugated hyperbilirubinemia may induce acute and chronic neurological complications. Severe hyperbilirubinemia can be prevented by first-line phototherapy (PT) treatment, but exchange transfusion (ET) is required if treatment is not effective, even if ET is linked with high hemodynamic, infectious, gastrointestinal, and/or biological morbidity. Intravenous human polyclonal immunoglobulins (IVIg) have been proposed in concomitant use with PT in order to avoid the requirement for ET in ABO FMI. METHODS: Electronic databases of all published clinical trials in neonatal hyperbilirubinemia due to ABO incompatibility were systematically queried for randomized controlled clinical trials comparing PT alone to PT associated with IVIg based on the requirement for ET. Duration of PT and adverse events were optional criteria. A meta-analysis of the selected data was performed on six selected trials out of 28 found. RESULTS: IVIg doses ranged from 0.5 to 1.5 g/Kg in one to three administrations. Requirement for ET was lower in the IgIV+PT group, with a relative risk of 0.27 [CI 95% 0.17-0.42; P<0.00001], expressed as a number needed to treat of five neonates to avoid one ET. The mean duration of PT was 4 days in the PT group and association of PT with IVIg significantly reduced the duration of PT treatment by 0.84 days. The tolerance of the IVIg and PT association was good with no reported cases of ulcerative enterocolitis in 265 treated newborns. CONCLUSION: IVIG associated with PT reduces the need for ET and the duration of PT in newborns with hyperbilirubinemia due to ABO hemolytic disease. Their efficacy and good tolerance prompt consideration of IVIg as a therapeutic adjuvant to PT in severe hemolytic hyperbilirubinemia due to ABO incompatibility.

[Therapeutic strategies for Escherichia coli neonatal meningitis]. / Stratégies thérapeutiques des méningites néonatales à Escherichia coli.

Outcome of early and late onset E. coli neonatal meningitis is poor with 12% (term infant) to 18% (premature infant) mortality rates. Early complications are cerebral abscesses, ventriculitis and ischemo-haemorragic cerebral lesions. Long term sequelae, particularly neurosensorial [14-17%] and neurodevelopmental [10-17%] are frequent. Delayed or unadapted antibiotic treatment is associated with an excess of complications. Main risk factors are hemodynamic failure, apnea, seizures, hypoglycorachia and abnormal EEG. Antibiotics must be started as soon as possible with a third generation cephalosporin (3GC). Cefotaxime is the most largely 3GC used with good tolerance and the most appropriate Pk/PD parameters, frequently in association with ciprofloxacin. Experimentally, neuroprotective drugs were recently proposed to improve prognosis such as inflammatory inhibitors, leakage bacterial components inhibitors, PMN penetration inhibitors in CSF, apoptosis regulators. Clinically protective effect of corticosteroids is discussed. Ciprofloxacin has an intrinsic anti-inflammatory activity and seems interesting to use in addition to conventional antibiotherapy during the first days of treatment. Prevalence of 3GC-resistant E. coli is 5% in the vaginal flora of pregnant women in some hospitals in France; this rate leads to reconsider first line antibiotic treatment and to switch cephalosporin with meropenem in neonates with confirmed gram negative bacilli or 3GC-resistant E. coli meningitis.

[NEOCAT, surveillance network of catheter-related bloodstream infections in neonates: 2010 data]. / Surveillance en réseau des bactériémies sur cathéter en néonatologie : résultats 2010 du réseau NEOCAT.

The NEOCAT surveillance network was implemented in 2006 in order to address catheter-associated bloodstream infections (BSIs) in neonates. The results for 2010 surveillance are presented herein. Neonatal intensive care units (NICUs) participated in the study on a voluntary basis. Umbilical catheters (UCs) and central venous catheters (CVCs) were analyzed separately. In 2010, 26NICUs participated. Overall, 2953 neonates were included (median weight, 1550 g; median gestational age, 32 weeks). These neonates had 2551UCs (median insertion duration, 4 days) and 2147CVCs (median insertion duration, 12 days). Thirty-three BSIs associated with UCs were reported, yielding a 2.9/1000UC-day incidence density, 95% confidence interval (95%CI) (1.9-3.8). UC-associated BSIs appeared after a median period of 5 days after UC insertion. The main microorganism isolated from blood cultures was coagulase negative staphylococci (CNS, n=27), S. aureus (n=3), and Enterobacteriaceae (n=5). Three hundred and six CVC-associated BSIs were recorded, yielding a 11.2/1000 CVC-day incidence density (95%CI, 10.0-12.5). These BSIs occurred after a median period of 12 days after CVC insertion. The main microorganisms were CNS (83%), S. aureus (6%), and Enterobacteriaceae (5%). The NEOCAT network provides a useful benchmark for participating wards.

Raman spectroscopic analysis of the clonal and horizontal spread of CTX-M-15-producing Klebsiella pneumoniae in a neonatal intensive care unit.

Nosocomial outbreaks of extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae are an increasing concern in neonatal intensive care units (NICUs). We describe an outbreak of ESBL-producing K. pneumoniae that lasted 5 months and affected 23 neonates in our NICU. Proton pump inhibitor and extended-spectrum cephalosporin exposure were significantly associated with the risk of ESBL-producing K. pneumoniae colonisation and/or infection. Thirty isolates recovered from clinical, screening and environmental samples in the NICU were studied by means of Raman spectroscopy, pulsed-field gel electrophoresis and repetitive extragenic palindromic polymerase chain reaction (rep-PCR). The Raman clustering was in good agreement with the results of the other two molecular methods. Fourteen isolates belonged to the Raman clone 1 and 16 to the Raman clone 3. Molecular analysis showed that all the strains expressed SHV-1 chromosomal resistance, plasmid-encoded TEM-1 and CTX-M-15 ß-lactamases. Incompatibility groups of plasmid content identified by PCR-based replicon typing indicated that resistance dissemination was due to the clonal spread of K. pneumoniae and horizontal CTX-M-15 gene transfer between the two clones.

[Neonatal exposure to active pulmonary tuberculosis in a maternity ward: screening and clinical course of a cohort of exposed infants]. / Contage tuberculeux néonatal en maternité : dépistage et évolution d'une cohorte de nourrissons exposés.

UNLABELLED: Few data are available on the impact of a tuberculosis exposure on newborns in a maternity ward. OBJECTIVES: To describe the screening and clinical course of infants exposed during the neonatal period to a caregiver with bacillary tuberculosis. PATIENTS AND METHODS: Infants exposed during the postnatal period in a maternity unit in Paris, from March to August 2005, to a caregiver with bacillary tuberculosis were included in a standardized screening protocol. The screening performed at baseline (M0) and at 3 months (M3) included a clinical evaluation, a tuberculin skin test (TST), and a chest X-ray. A preventive treatment for tuberculosis with isoniazid and rifampicin for 3 months was systematically proposed. RESULTS: At M0, 182 of the 217 infants (84%) with significant exposure were evaluated. Data were available for 172 infants. The median age at M0 was 4.9 months (IQR=3.8-6.2). At M0, 4 of 172 infants (2.3%) had latent TB infection. Between M0 and M3, 19 infants (11%) were lost to follow-up and 1 on 153 developed a latent TB infection. No cases of tuberculosis disease were diagnosed. The treatment was administered properly in 83% of cases and side effects were observed in 11% of infants without any serious adverse event. Four infants received no treatment and 11 stopped their treatment prematurely. CONCLUSION: In the absence of neonatal massive exposure, although low (2.9%), the risk of latent TB infection requires close monitoring of the infants exposed. However, in the context of a mild exposure in the maternity unit, surveillance without systematic initiation of TB preventive treatment could be discussed.

[Implication of extended-spectrum beta-lactamase enterobacteriaceae in nosocomial infections in neonates]. / Infections néonatales tardives à entérobactéries multirésistantes.

AIMS: The objective of this study was to determine the incidence of extended-spectrum beta-lactamase (ESBLS) enterobacteriaceae colonization and infection in hospitalized children. METHODS: This prospective study was conducted in a neonatal intensive care unit from 2000 to 2009. We recorded all isolations of ESBLs enterobacteriaceae from clinical samples that were obtained from hospitalized children. Anorectal samples were taken at admission and every 10 days. We systematically recorded cases of confirmed infections that was caused by ESBLs enterobacteriacea. RESULTS: A total of 46 ESBL(S) pathogens (E coli 58.7 %, Enterobacter cloacae 10.8 %, Klebsiella Pneumonia 19.5%, K. oxytoca 6.5 %, Citrobacter 4.5 %) were isolated during 10 years, the global incidence was 5.1 cases per 1000 admissions. Three infants developed nosocomial infections, E. coli sepsis and pneumonia and Enterobacter cloacae omphalitis. These patients were treated with carbapenem with significant clinical improvement. ESBLs enterobacteriaceae were found first in Klebsiella pneumonia and then predominantly in E. coli. Current efforts have focused on monitoring proper hand hygiene, evaluation of potential reservoirs of bacterial acquisition and transmission, cohorting and isolation of colonized infants, and fostering of effective inter- and intrahospital communication. Carbapenem seems to be safe in newborn and is recommended for the treatment of EBLSEs enterobacteriaceae infections.